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Seton Heart Institute Arrhythmia Center Seton is proud to offer your cardiac patients highly specialized treatment for their rhythm disorders. At the Arrhythmia Center, our goal is to provide excellent patient care through education, expertise and innovation. ARRHYTHMIA CENTER MEET THE CARDIAC ELECTROPHYSIOLOGY TEAM OF SETON HEART INSTITUTE Kristopher Heinzman, MD Dr. Heinzman trained at UT Southwestern in Dallas before moving to Austin four years ago. He works for Seton and is actively involved in the development of Dell Seton Medical School. Dr. Heinzman is currently the director of cardiac electrophysiology for Seton. Mauricio Hong, MD Dr. Hong completed cardiology training at UTHSC San Antonio, Clinical Cardiac Electrophysiology at Case Western Reserve University and completed advanced electrophysiology training at University of Toronto. He recently moved to Austin to practice in this vibrant community and teach at Dell Seton Medical Center at The University of Texas. Thomas “Bobby” Kurian, MD Dr. Kurian recently moved to Austin with his wife and four kids. He trained at UT Southwestern for Internal Medicine and completed his Cardiology and Cardiac Electrophysiology training at Washington University/BJH in St. Louis, MO. His expertise is in cardiac electrophysiology and biotechnology. Stephanie Targac, APN Stephanie earned both her Bachelor’s and Master of Science in Nursing degrees from The University of Texas at Austin. She has more than eight years of experience caring for patients with cardiac conditions. Stephanie serves as a board member for the Austin Advanced Practice Nurses, a group of local advanced practice providers involved in both professional and community education and outreach initiatives. She is fluent in both English and Spanish. To refer a patient, call (512) 324-3440 and specify EP referral. Learn more at Seton.net/HeartRefer OUR SPECIALISTS MANAGE AND TREAT THE FOLLOWING HEART RHYTHM DISORDERS: Atrial Fibrillation (AF) • Pulmonary vein isolation with Radio-Frequency Ablation for symptomatic PAF – Class I indication for treatment of PAF after failed one anti-arrhythmic drug – Class IIa indication if persistent symptomatic AF or PAF without a trial of anti-arrhythmic drugs • Alternative therapies for stroke prevention for patients with AF – LA occluder device therapy / Watchman device – coming soon Supraventricular Tachycardia (SVT) • Class I indication for catheter ablation as definitive treatment for AVNRT, Wolf Parkinson White Syndrome, typical counterclockwise atrial flutter and atrial tachycardia COMPREHENSIVE MANAGEMENT OF HEART ARRHYTHMIAS INCLUDES: Clinical Management • Atrial Arrhythmias – Atrial Fibrillation (AF) Atrial flutter • Supraventricular tachycardia –AVNRT – Atrial tachycardia – Accessory pathways – Ventricular Arrhythmias Ventricular tachycardia (VT) • Scar mediated (VT) (patients with MI, heart failure) Idiopathic VT (typically patients with normal hearts) Premature Ventricular Contractions (PVC) ■ ■ ■ ■ Device Implantation and Management • • • • • Pacemaker/ICD implantation Bi V PM/ICD implantation MRI compatible devices and MRI scanning capabilities Remote monitoring for pacemakers/ICDs LA appendage closure devices – Watchman device coming soon EP Outreach, Education and Telemedicine • Currently providing services at Seton Medical Center Austin, Seton Medical Center Williamson and Seton Medical Center Hays • Access to board-certified cardiac electrophysiologist to assist with questions in regards to rhythm disorders • Opportunities for physicians to earn CME credits online in atrial fibrillation management and associated rhythm disorders (coming soon) Clinical Research Protocols • Multiple ongoing clinical trials OVERVIEW OF SVT MANAGEMENT Clinical History of Palpitations 12 lead EKG in Normal Sinus Rhythm Pre-excitation (WPW) on 12 lead EKG? YES NO Suspect Orthodromic Reentrant Tachycardia (ORT) or Anti-dromic Reentrant Tachycardia (ART) Assess Arrhythmia pattern by clinical history, EKG, holter History of syncope? NO YE S YE S Documented SVT by EKG or holter? NO • Looping event monitor Referral to Seton Electrophysiology Services for further evaluation Consult line: (512) 324-3440 (specify EP) to further define etiology • If symptoms strongly suggest SVT without documentation then consider Seton EP evaluation for possible EP study or Implantable Loop Recorder ATRIAL FIBRILLATION ALGORITHM New onset/diagnosis of AF Clinical History Documented AF by 12 lead EKG or Holter, Obtain Echo, Blood Tests (TSH, Chem 10, LFTs) OSA? –> sleep study Risk factor modification • Diet/Exercise/Weight Loss • BP control • Glycemic control Rate Control Strategy Consider rate control first for patients: •Asymptomatic (paroxysmal, persistent) •Older, frail patients •Anti-arrhythmic drugs unsuitable •Cardio version unsuitable Initiate Anticoagulation based on ChadsVasc2 Unable to tolerate oral anticoagulation but high stroke risk ChadsVasc2? Difficulty with rate control or tolerating nodal blocking agents? • Possible Bi V Pacemaker and AV node ablation Consider rhythm control first for patients: •Symptomatic with AF (paroxysmal, persistent) •Younger •With heart failure Rhythm Control Strategy Rate Control Strategy Prescribe nodal blocking agents (Beta-blocker or Calcium Channel Blocker) if further rate control needed, add Digoxin Rhythm Control Strategy Consider left atrial occlusion/ exclusion device for CVA prevention Referral to Seton Heart Institute Arrhythmia Center for further evaluation (guided by Seton Heart Institute) •Initiation of antiarrhythmic drugs •Consideration for Pulmonary Vein Isolation Ablation SETON HEART INSTITUTE ARRHYTHMIA CENTER At Seton, our goal is to provide the best care possible with the dignity and respect that everyone deserves. Welcome to Humancare. Medical Park Tower 1301 West 38th St., Suite 400 Austin, Texas 78705 (512) 324-3440 Seton Williamson Medical Plaza I 301 Seton Parkway, Suite 302 Round Rock, Texas 78665 (512) 324-4812 Hays Medical Office Building I 1180 Seton Parkway, Suite 450 Kyle, Texas 78640 (512) 504-0860 Seton Burnet Specialty Clinic 200 CR 340A, Bldg. 4, Suite A Burnet, Texas 78611 (512) 715-3032 Seton.net/Heart